Results-driven and detail-oriented Certified Professional Coder (CPC) with over 6 years of progressive experience in outpatient coding, emergency department services, same day surgery (SDS), observation, ancillary services, risk adjustment (HCC), and fraud, waste & abuse (FWA) auditing. Demonstrated expertise in accurate ICD-10-CM, CPT, HCPCS, E/M, and modifier assignment in alignment with official coding guidelines, payer-specific policies, and regulatory requirements including HIPAA compliance.
Extensive background in Outpatient Prospective Payment System (OPPS), Medicare Advantage risk adjustment models, and value-based care contracts. Proven ability to abstract and analyze complex medical records across outpatient, inpatient, ED, and in-home assessment settings while maintaining 95%+ accuracy and consistently exceeding productivity benchmarks.
Experienced in denial prevention, documentation validation, claims auditing, and coding integrity review, contributing to clean claim submissions and reduced denial rates. Proficient in multiple coding and EMR platforms including Epic, MEDITECH, 3M Encoder, Optum360, CodeRight, HCC Coder, Avatar, and other healthcare systems.
Recognized for strong analytical skills, compliance-driven mindset, leadership support as Point of Contact (POC), and onboarding mentorship for new coders. Brings additional expertise in data privacy, healthcare IT systems management, and medical billing operations, offering a well-rounded perspective on healthcare revenue cycle and regulatory compliance.
Committed to continuous professional growth, coding excellence, and delivering high-quality, compliant healthcare documentation and reimbursement outcomes.
